Heart Sounds Assessment Documentation Form
Document key findings from a heart sounds assessment. Complete all sections for a comprehensive clinical record.
Patient Encounter Reference (MRN or Visit ID)
*
Assessment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Auscultation Site Findings
*
Rows
S1
S2
Extra Sounds (S3/S4)
Murmur
Aortic
1
2
3
4
Pulmonic
5
6
7
8
Tricuspid
9
10
11
12
Mitral
13
14
15
16
Heart Rate
*
Heart Rhythm
*
Regular
Irregular
Irregularly Irregular
Murmur Observed
*
None
Systolic
Diastolic
Continuous
Other
Extra Heart Sounds (S3, S4, Clicks, Rubs)
*
None
S3
S4
Click
Rub
Other
Comparison to Prior Assessment
*
No Change
Improved
Worsened
Not Applicable / First Assessment
Overall Heart Sounds Quality
*
1
2
3
4
5
Clinician Impression / Follow-up Note
*
Submit Assessment
Should be Empty: